Cassandra Callender, the teen who refused chemotherapy, has relapsed

I hate these stories, because they so seldom end well. Unfortunately, this one is more messy than even the usual messiness of the typical story of this type. The type of story I’m referring to, of course, is one that I’ve told from time to time ever since near the first year of this blog’s existence, that of the child or teen with cancer who, for whatever reason, refuses curative chemotherapy in favor of some sort of quackery. The litany of names depresses me to contemplate: Katie Wernecke, Abraham Cherrix, Sarah Hershberger, Daniel Hauser, Makayla Sault…the list goes on. In the vast majority of these cases, the child has a highly curable lymphoma or leukemia. Not infrequently, the child undergoes one or two rounds of chemotherapy, and the child and/or parent, alarmed at the side effects, decides that the child doesn’t need the rest of the chemotherapy course. This seems to be more likely to happen if the child has a great response to the first round or two of chemotherapy and goes into complete remission. Unfortunately, the chemotherapy regimens for childhood leukemias and lymphomas are long for a reason. Oncologists don’t give up to two and a half years of chemotherapy because they like poisoning children. Decades ago, they learned that if they didn’t give such prolonged courses of chemotherapy, the cancer was likely to return, even if it had gone into remission after only one or two courses of intensive chemotherapy. Unfortunately, that reality has led too many parents who, understandably, can’t stand seeing their children suffering chemotherapy effects to go along with prematurely stopping the chemotherapy.

As I’ve discussed many times before and reiterated yesterday, competent adults have the right to decide their own medical care. They can choose science-based medicine; they can choose no treatment at all; they can even choose quackery. Children, however, depend upon their parents to provide them with the best medical care, because they are not considered competent to make life-and-death decisions. There is, however, as I’ve also discussed before at various times, a bit of a “gray area.” Upon reaching the age of 18, a person is legally considered an adult. But what about 17 year olds? 16 year olds? For purposes of law, a cutoff age has to be decided on, but people are more complicated than that.
All of these issues informed my discussion of a teen named Cassandra Callender, whose case achieved some notoriety and national press coverage last year because the State of Connecticut ordered her to undergo chemotherapy for her Hodgkin’s lymphoma, a treatment that her doctors estimated to have approximately an 85% chance of curing her. What made Callender’s case different is that she never received a single dose of chemotherapy before refusing. Ultimately, the court ordered her to undergo chemotherapy.

Regular readers know that I invariably come down strongly on the side of making sure that children in these situations receive treatment for their cancer. However, Callender’s case was different, because when I wrote about it Callender was 17 years old and would be 18 a mere eight months later. IN other words, she was so close to being an adult that, even though she wasn’t legally an adult, I had a bit more of a difficult time supporting in essence locking her up in the hospital and forcing her to undergo chemotherapy. I also understand that not all of my readers shared my ambivalence about this court decision. Indeed, that’s one of the reasons why seeing and answering recent attacks on me cracked me up in a way; I’m not as ridiculously hard core as the quacks attacking me seem to think. Of course, it could just be that I’m soft on this issue.

The result last August, mere weeks before Callender was to turn 18, was an interview in which Callender repeats alternative medicine misinformation and rails against chemotherapy. Unfortunately, in that interview, there was a portent of doom that I didn’t pay a lot of attention to at the time but has become very relevant now. In the interview, she referred to a PET scan that she had last July that “didn’t look good” and how she was waiting for new scans at the time, leading her and Bollinger to express disgust about how “they” forced Cassandra to undergo chemotherapy that might not have completely eradicated the tumor. Of course, no treatment is 100% effective, but if there’s one thing we know about quacks, it’s that they are fond of black-and-white thinking.

A teenager who was forced by the courts to undergo chemotherapy for her cancer says a new mass has been found in her lungs.

Cassandra Callender, of Windsor Locks, disclosed the news Saturday on her Facebook page, posting an image of a CT scan dated Friday.

“This is the mass that is now inside of my lung,” she wrote. “I’ve known about this for a while, but it’s been hard going public with it. But this is why I fought so hard against chemotherapy. I am so sick of being treated like number and how everything is based off of statistics. I am a patient not a number.”

Obviously, this is bad news, but Callender’s illness is far from terminal, her situation far from unsalvageable; that is, it would be far from terminal and far from unsalvageable if she were willing to undergo conventional chemotherapy. Given that she was declared to be in remission last year, it appears that what she has now is a recurrence of her cancer. As bad as that is, her life can still be saved. It requires a difficult and arduous treatment, however. In general, the treatment of choice for relapsed or refractory Hodgkin’s lymphoma is salvage chemotherapy followed by autologous stem cell transplantation In other words, the patient’s bone marrow is harvested for stem cells, after which the patient undergoes high dose chemotherapy that wipes out her bone marrow and then has her bone marrow reconstituted by the harvested stem cells. It’s hard to predict the likelihood of success because I don’t know enough about Callender’s clinical situation, but salvage therapy of this type yields five year overall survival rates in the range of 40-60%.

That’s admittedly not great. It’s horrible indeed to be 18 years old and facing a future of high dose chemotherapy and a bone marrow transplant whose chance of saving letting her live five years is probably around 50-50 and of rendering her cancer-free for that time is around one in three. But you know what? Assuming that lung mass as shown on Callender’s GoFundMe page is indeed lymphoma (as it appears), that’s a better chance than she has with alternative cancer treatments, which is basically zero. I don’t know what specific alternative cancer treatments that Callender wants to undergo. Her previous interview with Ty Bollinger suggests that she was interested in “natural and homeopathic” treatments. I know what homeopathic treatments are, obviously, but “natural” can mean almost anything.

Callender, of course, exhibits magical thinking on the same scale that we’ve seen time and time again in cancer patients who’ve chosen quackery over real medicine. For instance, in her last interview, she said:

Either way I’m still doing something for my health. A lot of people in media have misinterpreted, saying that I wanted to die of cancer instead of treatment, but that’s not true. I simply didn’t want the chemotherapy, something that was less harmful to your body. Cancer is harmful enough to your body. Why would you want to add more to that?

Later, she says:

I never wanted to die. I wanted another way to live.

Of course, she doesn’t want to die. No cancer patient who decides to forego chemotherapy She just doesn’t seem to understand that her choice to forego salvage therapy virtually guarantees that she will die, and die unpleasantly. Unfortunately, part and parcel of the magical thinking that leds people like Callender to choose quackery over medicine also tends to lead them not to understand that death from cancer is anything but dignified and free of suffering.

Unfortunately, I’ve seen that movie too. I know where this story is going. Callender will likely feel fine for a while. She’ll seek out “natural cancer treatments,” and it wouldn’t surprise me if she features in the next update of Ty Bollinger’s Truth About Cancer series or some other pro-quackery propaganda documentary. For a time, she’ll be a celebrity among the alternative cancer cure crowd, featured at various quack conferences as a “success story.” Then, sadly, sooner or later her cancer will progress. She will die a horrible death and she will be quickly forgotten by the very people who used her to sell their pseudoscientific world view and thereby facilitate their sale of cancer quackery. If they acknowledge her death at all, they’ll blame the chemotherapy she had last year for “weakening her immune system” or some such nonsense instead of the failure of whatever quackery she is using now.

Then they’ll just move on to the next mark. Unfortunately there is never a shortage of new marks.